Adherence to HAART: A Systematic Review of Developed and Developing Nation Patient-Reported Barriers and Facilitators

By E. Mills, J. Nachega, D. Bangsberg, Sonal Singh, B. Rachlis, Ping Wu, K. Wilson, Iain E. Buchan, C. Gill, C. Cooper. PLoS Medicine, 2006

852 citations recorded by the source corpus.

Background Adherence to highly active antiretroviral therapy (HAART) medication is the greatest patient-enabled predictor of treatment success and mortality for those who have access to drugs. We systematically reviewed the literature to determine patient-reported barriers and facilitators to adhering to antiretroviral therapy. Methods and Findings We examined both developed and developing nations. We searched the following databases: AMED (inception to June 2005), Campbell Collaboration (inception to June 2005), CinAhl (inception to June 2005), Cochrane Library (inception to June 2005), Embase (inception to June 2005), ERIC (inception to June 2005), MedLine (inception to June 2005), and NHS EED (inception to June 2005). We retrieved studies conducted in both developed and developing nation settings that examined barriers and facilitators addressing adherence. Both qualitative and quantitative studies were included. We independently, in duplicate, extracted data reported in qualitative studies addressing adherence. We then examined all quantitative studies addressing barriers and facilitators noted from the qualitative studies. In order to place the findings of the qualitative studies in a generalizable context, we meta-analyzed the surveys to determine a best estimate of the overall prevalence of issues. We included 37 qualitative studies and 47 studies using a quantitative methodology (surveys). Seventy-two studies (35 qualitative) were conducted in developed nations, while the remaining 12 (two qualitative) were conducted in developing nations. Important barriers reported in both economic settings included fear of disclosure, concomitant substance abuse, forgetfulness, suspicions of treatment, regimens that are too complicated, number of pills required, decreased quality of life, work and family responsibilities, falling asleep, and access to medication. Important facilitators reported by patients in developed nation settings included having a sense of self-worth, seeing positive effects of antiretrovirals, accepting their seropositivity, understanding the need for strict adherence, making use of reminder tools, and having a simple regimen. Among 37 separate meta-analyses examining the generalizability of these findings, we found large heterogeneity. Conclusions We found that important barriers to adherence are consistent across multiple settings and countries. Research is urgently needed to determine patient-important factors for adherence in developing world settings. Clinicians should use this information to engage in open discussion with patients to promote adherence and identify barriers and facilitators within their own populations.

Subfields: Family Practice, Infectious Diseases

View Paper: https://www.semanticscholar.org/paper/669c240861865c733d2e919d0bbb6ad2cb85ef9c

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Citations in the corpus

Determinants of patient adherence: a review of systematic reviews (2013, background): “Poor drug supply (e.g., poor TB medication availability at health care facilities) (Mills et al., 2006; Munro et al., 2007) Unavailability of medications (e.g., prescription ran out) (Vik et al., 2004) Receiving treatment together with methadone from a street nurse (for DOT in TB, in IDU patients)…”
A review of health behaviour theories: how useful are these for developing interventions to promote long-term medication adherence for TB and HIV/AIDS? (2007, result): “These lay theories of adherence with regard to antiretroviral [ 81 ] and TB treatment [75] are discussed elsewhere.”
Convergent and sequential synthesis designs: implications for conducting and reporting systematic reviews of qualitative and quantitative evidence (2017, background): “For example, in a review aiming at identifying the obstacles to treatment adherence, the qualitative synthesis provided a list of barriers and the quantitative synthesis reported the prevalence of these barriers and knowledge gaps (barriers for which prevalence was not estimated) [37].”
Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders (2011, background): “The four text message interventions were chosen to address different barriers to adherence such as forgetfulness and lack of social support [24,25].”
Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa: A Systematic Review (2007, background): “A good deal of research on barriers to adherence and reasons for treatment discontinuation has been published [13].”